How to legally get Topamax online

Understanding Your Telehealth Access for Binge Eating Disorder Treatment

If you’re seeking treatment for Binge Eating Disorder (BED), you may wonder if medications like Topamax (topiramate) and Wellbutrin (bupropion) can be prescribed through telehealth appointments. The good news is that these medications remain widely accessible via telehealth across the United States, even as regulations continue to evolve.

This comprehensive guide explains the current telehealth rules for BED treatment as of 2026, what you can expect from the process, and how to ensure you’re receiving care that meets both legal requirements and clinical standards.

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Can You Get BED Medications via Telehealth in 2026?

Yes – For non-controlled medications like Topamax (topiramate) and Wellbutrin (bupropion), telehealth providers can legally prescribe them in every state, provided they are licensed in your state and follow standard care protocols.

These medications are not controlled substances, meaning they aren’t subject to the stricter DEA regulations that govern medications like stimulants or opioids. While there’s been much discussion about telehealth rules for controlled substances, non-controlled medications for BED treatment have remained consistently accessible via telehealth platforms.

Federal vs. State Rules: What Applies to You?

Federal Regulations

At the federal level, there are no special restrictions on prescribing non-controlled medications via telehealth. The Ryan Haight Act, which some patients have heard about, only applies to controlled substances – not to medications like Topamax or Wellbutrin.

The DEA recently extended telehealth flexibilities for controlled substances through December 2026 while they work on permanent rules, but this extension primarily affects medications classified as controlled substances (like Vyvanse, which is FDA-approved for BED but is a controlled stimulant). For the non-controlled medications commonly used off-label for BED, federal telehealth rules remain open and flexible.

State-by-State Variations

While federal law doesn’t restrict telehealth prescribing of non-controlled medications, states do have some variations in their requirements:

• States with no special in-person requirements: Most states, including California, Delaware, Florida, Michigan, New York, Texas, and Wisconsin, have no in-person exam requirement for non-controlled medications. A telehealth evaluation is sufficient for prescribing.

• States with periodic in-person follow-up requirements: A few states, including Alabama, Georgia, and New Hampshire, require an in-person visit within 12 months if you receive ongoing telehealth care. However, this can often be satisfied by any collaborating provider (not necessarily your telehealth doctor).

• Medical board expectations: Even without specific laws, all states expect telehealth providers to deliver care that meets the same standards as in-person care. This means a thorough evaluation before prescribing any medication.

What to Expect from a Telehealth BED Medication Consultation

The Evaluation Process

A legitimate telehealth evaluation for BED should include:

1. Verification of identity and location – The provider will confirm who you are and where you’re located to ensure they’re licensed in your state.

2. Comprehensive medical history – Expect detailed questions about your eating behaviors, mental health history, other medical conditions, and current medications.

3. BED diagnostic assessment – The provider will assess whether you meet the clinical criteria for Binge Eating Disorder based on DSM-5 guidelines, which include:

• Episodes of eating an unusually large amount of food within a 2-hour period
• Feeling a lack of control during these episodes
• Experiencing these episodes at least once weekly for 3 months
• Marked distress about the binge eating
• Absence of compensatory behaviors like purging or excessive exercise

1. Discussion of treatment options – A quality provider will discuss multiple approaches, not just medication. This may include therapy options, nutritional counseling, and support groups alongside potential medication.

2. Informed consent – You’ll review and consent to telehealth treatment and acknowledge any off-label medication use (since both Topamax and Wellbutrin are used off-label for BED).

Medication Selection and Monitoring

If medication is deemed appropriate, your provider will consider:

• Your medical history – Certain conditions may make one medication more suitable than another. For example, a history of seizures might make Wellbutrin inappropriate.

• Prior treatments – What has worked or not worked before?

• Potential contraindications – For instance, Wellbutrin is contraindicated if you have a history of anorexia or bulimia due to seizure risk, and Topamax is not recommended during pregnancy.

• Follow-up schedule – A reputable provider will establish a clear follow-up plan to monitor your progress and any side effects.

At Klarity Health, our providers carefully evaluate each patient’s unique situation to determine the most appropriate treatment path. Our telehealth platform connects you with experienced providers who understand the complexities of BED treatment and can offer personalized care plans that may include these medications when appropriate.

Nurse Practitioners and Physician Assistants: Who Can Prescribe?

The ability of Nurse Practitioners (NPs) and Physician Assistants (PAs) to prescribe BED medications via telehealth varies by state:

Full Practice Authority States

In about 34 states (plus DC), NPs now have full practice authority, meaning they can evaluate and prescribe medications like Topamax and Wellbutrin without a doctor’s direct oversight. Recent additions to this group include Louisiana, Kansas, Wisconsin, and Michigan, which updated their laws between 2023-2025.

Collaborative Agreement States

In other states, NPs and PAs must work under a collaborative agreement with a physician to prescribe medications. This is common in southeastern states like Florida and Texas. While this doesn’t typically affect the care you receive, you might see both the NP’s and the collaborating physician’s names on your prescription.

What This Means for Patients

Practically speaking, any licensed prescriber (MD, DO, NP, or PA) working with a telehealth service can prescribe these BED treatments, as long as they follow their state’s collaboration rules. At Klarity Health, we ensure all our providers are fully licensed and following appropriate state regulations, whether they’re physicians or advanced practice providers.

Off-Label Medication Use for BED Treatment

Both Topamax and Wellbutrin are considered ‘off-label’ for BED treatment. This means:

• Topamax is FDA-approved for seizures and migraines, but has clinical evidence supporting its use in BED.
• Wellbutrin is FDA-approved for depression and smoking cessation, but studies show it can help reduce binge frequency in some patients.

Off-label prescribing is legal, common, and often supported by clinical research. Your provider should:

1. Explain that the medication is being used off-label
2. Discuss the evidence supporting this use
3. Review potential benefits and risks
4. Document your informed consent

A quality telehealth provider will be transparent about why they’re recommending a specific medication and be open to discussing alternatives if you have concerns.

Safety Considerations and Red Flags

Who May Not Be a Good Candidate for Telehealth BED Treatment?

Not everyone is an appropriate candidate for telehealth BED treatment with these medications. Safety factors that might require in-person care include:

• History of anorexia or bulimia – Wellbutrin is contraindicated due to seizure risk
• Uncontrolled epilepsy or seizure disorders – These conditions require careful medication selection
• Pregnancy or planning pregnancy – Topiramate can cause birth defects
• Severe medical instability – Very severe obesity with urgent health issues, uncontrolled diabetes, etc.
• Need for controlled medications – If Vyvanse (the only FDA-approved medication for BED) is indicated, telehealth rules are stricter

Red Flags in Telehealth Providers

Be cautious of telehealth services that:

• Promise a prescription before a proper evaluation
• Skip discussing non-medication treatment options
• Conduct extremely brief consultations (under 10 minutes)
• Start medications at unusually high doses
• Send medications directly rather than using a legitimate pharmacy
• Don’t offer follow-up care

Refills and Follow-Up Care

One advantage of non-controlled medications is that providers can often write prescriptions with refills (typically up to 6-11 months, depending on state limits). However, regular follow-up appointments are still essential, especially when starting treatment.

A typical telehealth follow-up schedule might include:

1. Initial evaluation
2. 2-week or

Source:

• https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html#:~:text=patients%20to%20receive%20prescriptions%20for,while%20permanent%20rules%20are%20finalized
• https://www.sheppardhealthlaw.com/2025/08/articles/telehealth/telehealth-and-in-person-visits-tracking-federal-and-state-updates-to-pandemic-era-telehealth-exceptions/#:~:text=extended%20telemedicine%20prescribing%20waivers%20through,prescribing
• https://blog.healthjobsnationwide.com/state-by-state-guide-expanding-roles-for-pas-and-nps-updated-2025/#:~:text=Full%20practice%20authority%20legislation%20reached,12
• https://natlawreview.com/article/telehealth-and-person-visits-tracking-federal-and-state-updates-pandemic-era?amp=#:~:text=coordination%20with%20the%20U,prescribing
• https://telehealth.hhs.gov/providers/telehealth-policy/prescribing-controlled-substances-via-telehealth#:~:text=The%20Drug%20Enforcement%20Administration%20,through%20December%2031%2C%202025
• https://natlawreview.com/article/telehealth-and-person-visits-tracking-federal-and-state-updates-pandemic-era?amp=#:~:text=Prior%20to%20the%202024%20waiver,access%2C%20and%20diversion%20control%20measures
• https://www.cchpca.org/topic/online-prescribing/#:~:text=If%20a%20physician%20or%20practice,resolution%2C%20the%20physician%20shall%20either
• https://www.cchpca.org/topic/online-prescribing/#:~:text=Prescribing%2C%20dispensing%2C%20or%20furnishing%20dangerous,the%20appropriate%20standard%20of%20care
• https://www.cchpca.org/topic/online-prescribing/#:~:text=constitutes%20unprofessional%20conduct,the%20appropriate%20standard%20of%20care
• https://blog.healthjobsnationwide.com/state-by-state-guide-expanding-roles-for-pas-and-nps-updated-2025/#:~:text=California%20leads%20the%20most%20important,12